# SOUTHEAST KENTUCKY CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982703617
- **Authorized official:** YASSER NADIM (PRESIDENT)
- **Authorized official phone:** (606) 679-1189

## Contact information

- **Practice address:** 402 BOGLE ST, SUITE 2, SOMERSET, KY 42503-2870
- **Practice address phone:** (606) 679-1189
- **Mailing address:** 402 BOGLE ST, SUITE 2, SOMERSET, KY 42503-2870
- **Mailing address phone:** (606) 679-1189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 34018 | KY | Yes |

## Other

- **Enumeration date:** 09/21/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 65933681 | — | KY |